Ukwelashwa kwamadoda amabili ekuphepheni kwepilisi kuphakamisa ukukhathazeka
Kwabikwa kabanzi ngoFebhuwari 25, 2016 ukuthi indoda ethatha isidakamizwa sokuvimbela i-HIV, i- Truvada , yatholwa yilolu gciwane nakuba ihambisana ngokugcwele nomuthi wodokotela wezinsuku zonke. Lezi zindaba zaveza ukukhathazeka okukhulu kwabanye ngokuthi indlela eyaziwa ngayo njenge-HIV pre-exposure prophylaxis (i- PrEP )-empeleni iqinisekisa ukuthi abantu abangenayo igciwane lesandulela ngculazi bahlala bengenasithintekile.
Embikweni wabo, abaphenyi abane-Maple Leaf Medical Clinic (MLMC) eCanada baqinisekisa ukuthi indoda engama-gay eneminyaka engu-43 ubudala ihlole i-HIV ngenkathi i-PrEP, nokuthi ukubuyekezwa kokubili kwamarekhodi ekhemisi kanye nokuhlolwa kwezidakamizwa zokwelashwa ( esetshenziselwa ukulinganisa ukuxilongwa kwezidakamizwa egazini) ubufakazi obukhokhelwe izinga eliphezulu lokuhambisana nomuntu.
Ukuhlolwa okuqhubekayo kwezakhi zofuzo kwaveza ukuthi le ndoda yayithole uhlobo oluthile oluthile lwe-HIV , olwaluphikisana namakhemikhali amabili ezidakamizwa ahlanganisa iTruvada.
Ngakho umbuzo uhlala: ingabe leli cala "lingavamile" njengoba abanye abezindaba bebike? Noma ingabe lesi sigameko, eqinisweni, siveze ukuthi kungenzeka yini ukuthi i-chink ingakwazi ukuvikela isisombululo se-HIV?
I-Real-World Efficacy ye-PrEP
Iningi lezinhlangano ze-HIV namuhla zizokukwazisa ukuthi i-PrEP, uma ithathwa kahle ngendlela yeTruvada tablet, inganciphisa ingozi yomuntu yokuthola i-HIV ngamaphesenti angu-90 noma ngaphezulu.
Bazoqapha futhi abasebenzisi, ikakhulukazi labo abasengozini enkulu , ukuthi izidakamizwa akufanele zisetshenziswe ngokuzihlukanisa kodwa njengengxenye yohlelo lokuvimbela igciwane lesandulela ngculazi (kubandakanya amakhondomu, ukunciphisa inani labalingani bobulili njll)
Kodwa umlayezo uvame ukufakela emphakathini ngezindlela ezihluke kakhulu, abezindaba bezenhlalo kanye nezitolo zezindaba ngokuvamile kuphezu kwe-hyping noma ukufakaza ubufakazi obunjalo.
Namuhla kuyinto engavamile ukuzwa ukuthi i-PrEP "iphumelela ngamaphesenti angu-99" ekuvikeleni i-HIV, noma ukubona ukucwaninga kwezemvelo ukuze kuqinisekiswe ukuthi i-PrEP "amaphesenti angu-100 aphumelelayo" phakathi kwamadoda abesilisa abengozini kakhulu abasebenzisi amakhondomu .
Futhi kuyilapho kuyiqiniso ukuthi ezinye izifundo phakathi kwamadoda angama-gay abengozi kakhulu ziye zabika akukho ukutheleleka phakathi kwalabo abathintekayo ngokugcwele ukwelapha, lezi zinhlobo zemiphumela aziguquleli ezimweni zangempela-jikelele, lapho abaningi abadidekayo benganciphisa kakhulu ukusebenza kwe-PrEP izinga elilodwa.
Kuyiziningi zalezi zinkimbinkimbi ezibeka isigameko saseCanada ngokukhanya okukhulu.
Izinto Ethinta Ukusebenza Kwe-PrEP
Ekucwaningweni kwabo, abaphenyi baseMLMC basikisela ukuthi indoda yaseCanada itholwe ngumlingani olwa negciwane lesandulela ngculazi ogama lakhe lokwelapha i-antiretroviral. Ngemuva kokuhlolwa kokuvivinya izakhi zofuzo , igciwane lomlingani likhonjiswe ukuthi liyamelana kokubili i-tenofovir ne-emtricitabine (izidakamizwa ezakhiwa yi-Truvada), ngokuqeda ngokuphumelelayo inzuzo yokuvikela ye-PrEP.
Nakuba amanye ama-pundits asho ukuthi lolu hlobo lokumelana nezidakamizwa eziningi aluvamile-ngokusakazeka kwamaphesenti angaphansi kwesinye-olunye ucwaningo lubonisa isithombe esincane. Siyazi, isibonelo, ukuthi ukumelana ne-tenofovir okwamanje kugijima noma yikuphi okuvela kumaphesenti angu-20 (eYurophu) kuya kuma-57 amaphesenti (e-Afrika) phakathi kweziguli ezingelahleki, ngokusho kombiko we-2016 we-TenoRes Study Group.
Ezimweni ezinjengalezi, noma ngabe ingxenye ye-emtricitabine izohlala isebenza kahle, ikhono layo lokuvimbela ukutheleleka lihlala, ngokusemandleni kakhulu, eliphansi. Le mibuzo yedwa kuphela ukuthi izimo zokutheleleka enkantolo yaseCanada ziyizinto "ezingavamile," kuyilapho kuqokomisa izinselele ezibhekene nemiphakathi lapho amazinga okuphikiswa kwe-tenofovir ephakeme.
Okwamanje, ezinye izingxabano zingase zinciphise ukusebenza kwe-PrEP. Omkhulu phakathi kwabo:
- Ukwehluleka ukufeza nokugcina amazinga anele weTruvada egazini. Nakuba ukulingana okungahambisani nokuvame ukuvame ukungaboni ngaso sonke isikhathi, kubonakala ukuthi iziguli eziqala i-PrEP zidinga ukwelashwa ezinsukwini ezingu-20-30 ngaphambi kokuba umuthi ungabhekwa njengempumelelo. Uma amazinga omuthi wokwelashwa efinyeleleka, ama-dose angabanjwanga okwezinye izikhathi angabi nenkinga enkulu-okungenani kubahlali besilisa abesilisa abathandanayo.
- Ukungafani ekusebenzeni kwe-PrEP ngamadoda angama-gay ngokumelene nabesifazane abesilisa nabesifazane. Kukhona nobufakazi bokuthi iPrEP ingase ingabi ngempumelelo kulabo besifazane nokuthi ngisho nokuqedela okuphelele, okungaphazamiseki, inzuzo yokuvikelwa ingase iwele phansi ngaphansi kwamaphesenti angama-90 kubonwe amadoda angama-gay.
Ngokuphelele kwazo, la maqiniso akhombisa izinto ezimbili: ukuthi ukusebenza kwe-PrEP kwezinye izindawo kuzoba kuncane kunabanye, futhi ukuthi isidingo samakhondomu nezinye izinyathelo zokuvimbela zihlala zifanelekile kunanini ngaphambili.
PrEP nama-Multiple Sex Partners
Njengoba kukhulunywa lokho, ukusebenza kwe-PrEP akubonakali ukuthi kuncishiswe ngokweqile ngezici eziningi zengozi eziphathelene nokutheleleka. Nakuba ukusetshenziswa kwekhondomu engavumelani kanye nabalingani abaningi bezocansi, ngokwesibonelo, bayaziwa ukwandisa amathuba okwelapha i-HIV, akusho ukuthi kunciphise ukusebenza kwe-PrEP kubantu abengozi kakhulu.
Eqinisweni, phakathi kwamadoda abesilisa abesilisa abathandana nabo abonakala bephakathi kwezinga eliphakeme kakhulu lezingozi, ukusetshenziswa kwe-PrEP kusengaphansi kokuxhaswa okulinganiselwa kuma- 86% okuvikela okungafani nabalingani abangasebenzisi i-PrEP. Inzuzo ibonakala sengathi yanda kulabo abasebenzisa amakhondomu njalo, futhi banciphisa inani labo labalingani bobulili (ikakhulukazi labo abangaziwa ngesimo noma isimo sokwelapha).
Ngalokho kuthiwa, i-PrEP namanje ayikwazi ukubhekwa njenge "magic bullet" ukuthi ngandlela-thile inganaki izinzuzo zezinye izinhlobo zokuvikelwa, njengamakhondomu. Ngo-February 2017, owesilisa wesithathu wavivinya ngesikhathi esifanele ku-PrEP. Kodwa-ke, kulokhu, abacwaningi bakholelwa ukuthi ukudluliselwa kwenzeka okwenziwe ngenxa enkulu "yenani eliphawulekayo" labalingani bobulili abebenalo.
Indoda eneminyaka engu-50 ubudala yaseDutch yayiyingxenye yokucwaninga kwe-European PrEP futhi yabika abalingani abangaphezu kuka-90 kwezocansi kanye nezenzo ezingaphezu kuka-100 zesondo zangasese ezingenalo ikhondomu ngesikhathi sokuhlolwa kweviki ezingu-12. Ngesikhathi ese-PrEP, le ndoda yayiphenywe kabili nge-gonorrhea ye-rectal futhi kanye ne-chlamydia engumhlanga.
Ngenkathi isimo esibi kakhulu secala senze ukuba bakholelwe ukuthi lesi senzakalo esisodwa, abanye abaqinisekisiwe. Ekuhloleni igciwane lomuntu, bathola ukuthi akukho ukuguqulwa kwegciwane lesandulela ngculazi kwanoma yiluphi uhlobo futhi leli gciwane lakhe libhekwa ngokuthi "uhlobo olusendle."
Lokho kusho lokhu, ukuthi, uma enikezwe irekhodi lakhe lokunamathela, izidakamizwa kufanele zihlinzekele ukuvikelwa ngaphandle kokuthi ezinye izici zenzeke ukutheleleka. Uma kunjalo, lezi zici ezingaziwa zingase zibeke abanye engozini. Kuze kube yilapho abacwaningi bekwazi okwengeziwe, imikhuba yobulili ephephile kufanele ilandelwe uma kuphela ukunikeza ungqimba olwengeziwe lokuvikelwa.
Imithombo:
> Hoornenborg, E. no de Bree, J. "Ukwelashwa Okumangalisayo Ngomuthi Wama-Wild-Type HIV-1 ku-PrEP User With Level High TDF." Ingqungquthela ye-Retroviruses kanye nezifo ezivame ukubhekana nazo; Seattle, Washington; Ngo-February 13-16, 2017; abstract 953.
> Molina, J .; I-Capitator, C .; I-Spire, B.; et al. "On-Demand Preexposure Prophylaxis Emadodeni Atengozini Ephezulu Yokutheleleka nge-HIV-1." I-New England Journal of Medicine. Ngo-Disemba 1, 2015; eshicilelwe ku-inthanethi kusengaphambili kokuphrinta; I-DOI: 10.1056 / NEJMoa1506373.
> I-POZ Magazine. "I-PrEP ihluleka kumuntu we-Gay Unamathele ku-Daily Truvada, Usebenzisana ne-HIV-Anti-drug resistant." Ngo-Februwari 25, 2016.
> I-TenoRes Study Group. "I-epidemiology yomhlaba wonke yokumelana nezidakamizwa ngemuva kokuhluleka kwe-WHO ukuphakamisa izigaba zokuqala zokutheleleka kwe-HIV-1: isifundo sezinhlobonhlobo eziphindaphindiwe ze-HIV." Izifo ezithathelwanayo zeLancet. NgoJanuwari 28, 2016; eshicilelwe ku-inthanethi I-DOI: 10.1016 / S1473-3099 (15) 00536-8.
> I-UK PROUD Trial Steering Committee. "Ukuhlaziywa kwesikhashana okufingqiwe kwe-PROUD pro-relaxation prophylaxis (i-PrEP) kuvimbela kakhulu ukulwa ne-HIV kubantu besilisa nabesilisa abesilisa nabesifazane abase-UK." ILondon, eNgilandi; ukushicilelwa okukhishwe ngo-Okthoba 16, 2014.